Ocular flutter in suspected multiple sclerosis: a presenting paroxysmal manifestation

Abstract

Summary A patient with suspected multiple sclerosis is described who presented with attacks of blurring of vision and ocular flutter. This has not previously been reported as an isolated paroxysmal manifestation of brain stem demyelination. As with other paroxysmal disturbances ocular flutter may present as the first sign of the disease.

Unusual ocular motor findings in multiple sclerosis

“…Furthermore, brain MRI was typical for MS and the patient had 4 other relapses during the follow-up. Isolated opsoclonus is rare and, to our knowledge, has never been described as the first manifestation of MS. Two previous cases of ocular flutter, which is similar to opsoclonus, have been described during a relapse of MS [12,16], with a focal MRI lesion in the medial region of the PPRF in the second case. However, as in our patient, no lesion was observed, nor has any lesion been evidenced in post-mortem cases [17].…”

Efferent Visual Dysfunction From Multiple Sclerosis

“…[39][40][41][42][43][44] Uncommon eye movement abnormalities such as ocular flutter and see-saw nystagmus have been reported in MS. [45][46][47] Isolated cranial nerve involvement is uncommon in MS, occurring in 1.6% of patients in one series, with abducens palsy being most common (Fig. 4).…”

Saccadic oscillations: membrane, model and medicine

“…Similarly, saccadic oscillations are present in patients with gross structural deficits that impair the function of specific cell populations or their connections. For example saccadic oscillations are seen in degenerative disorders of cerebellar Purkinje neurons [3], demyelinating disease [4], or intracranial mass [5]. Saccadic oscillations can also occur in subjects without structural neurological deficit.…”

“…Patients with demyelinating disease or developmental absence of myelination can present with saccadic oscillations[4,11]. It is hypothesized that saccadic oscillations in patients with lack of myelin is due to the abnormal delay in the conduction through the crossing tracks of the reciprocally innervating pontine burst neurons.…”